DESCRIBING SLEEP AND SEDATION PRACTICES IN THE ICU: A MULTINATIONAL SURVEY

Introduction Sleep disturbances are common in critically ill patients treated in the intensive care unit (ICU) with the potential for serious consequences and long-term effects on health outcomes and patient morbidity.
Objectives Our aim was to describe sleep management and sedation practices of adult ICUs in ten countries and to evaluate roles and responsibilities of the ICU staff in relation to key sleep and sedation decisions.
Methods A multicenter, self-administered survey sent to nurse managers of adult ICUs across 10 countries. The questionnaire comprised four domains: sleep characteristics of the critically ill; sleep and sedation practices; non-pharmacological and pharmacological interventions used to improve sleep; and the autonomy and influence of nurses on sleeping practices in the ICU.
Results Overall response rate was 66% (range 32% UK to 100% Cyprus), providing data from 522 ICUs. In all countries, the most frequent patient characteristic perceived to identify sleep was lying quietly with closed eyes (N=409, 78%) (range 92% Denmark to 36% Italy). The most commonly used sedation scale was the Richmond Agitation-Sedation Score (RASS) (N=220, 42%) (range 81% UK to 0% Denmark, Cyprus where most ICUs used the Ramsay score). In most ICUs, selection of sleep medication (N=265, 51%) and assessment of effect (N=309, 59%) was performed by physicians and nurses based on collaborative discussion. In a minority of ICUs (N=161, 31%), decisions and assessments were made by physicians alone. The most commonly used (in all countries) non-pharmacological intervention to promote sleep was reducing ICU staff noise (N=473, 91%) (range 100% Denmark, Norway to 78% Canada). Only 95 ICUs (18%) used earplugs on a frequent basis (range 0% Greece, Cyprus, Denmark to 57% Sweden). Propofol was the drug used most commonly for sedation (N=359, 69%) (range 96% Sweden to 29% Canada). Chloral hydrate was used by only 63 (12%) ICUs (range 0% Greece, Cyprus, Denmark, Italy to 56% Germany). Sedation scales were used on a routine basis by 77% of the 522 ICUs. Participants scored nursing autonomy for sleep and sedation management as moderate; median score of 5 (scale of 0 to 10), range 7 (Canada, Greece, Sweden) to 4 (Norway, Poland). Nursing influence on sleep and sedation decisions was perceived considerable; median score 8, range 9 (Denmark) to 5 (Poland).
Conclusions We found considerable across country variation in sleep promotion and sedation management practices though most have adopted a sedation scale as recommended in professional society guidelines. Most ICUs in all countries used a range of pharmacological and non-pharmacological interventions to promote sleep. Most units reported inter-professional decision-making with nurses perceived to have substantial influence on sleep/sedation decisions.

Opportunities and constraints of transhumant small ruminant production in the Chinese Altay Mountains

This PhD thesis focuses on current livelihoods of agro-pastoral livestock keepers, their animal nutrition, herd and rangeland management strategies. It thereby aims to contribute to sustainable rangeland management, livestock production and household income in Qinghe county of the Chinese Altay Mountain region, located in Xinjiang Uyghur Autonomous Region, PR China. In its first part the study characterizes the socio-economic situation and agricultural practices of agro-pastoralists through structured household interviews. The second part provides insights into the grazing behaviour and feed intake of small ruminants on seasonal pastures in this region, and into the quantitative and qualitative biomass offer on natural rangelands. The third part analyses the reproductive performance and annual growth of the local sheep and goat herds, and, by modelling improved feeding and culling strategies, tests herd management options that potentially improve the monetary output per female herd animal without increasing the pressure onto natural rangelands. Taken together, the results of the study suggest that, despite an increase and intensification of cropping and vegetable gardening in the region of Qinghe, livestock rearing is still the major livelihood strategy both in terms of prevalence and relative importance. However, livestock keeping is challenged by low biomass production on rangelands, due to the combined impact of high climate variability and highly localized grazing pressure on the seasonal pastures. Though government regulations try to tackle the latter aspect, their implementation is sometimes difficult. Alternatives to strict regulation of grazing periods and animal numbers on seasonal pastures are, in the case of goats, more rigorous culling strategies and, in the case of sheep and goats, strategic supplementation of the animals in the winter and spring season. However, for the latter strategy to become economically viable, an improvement of live animal and meat marketing options and an investment in local meat processing facilities that add value to the carcasses is needed. As the regional cities grow rapidly, the potential market to absorb diverse and good quality meat products is there, along with the road network connecting Qinghe county to the regional capital. Such governmental measures will not only create new job opportunities in the region but also benefit the cash income of pastoralists in this westernmost region of China.

Influence of Forecasting, Planning and Controlling on the performance of Small and Medium Enterprises

Production Planning and Control (PPC) systems have grown and changed because of the developments in planning tools and models as well as the use of computers and information systems in this area. Though so much is available in research journals, practice of PPC is lagging behind and does not use much from published research. The practices of PPC in SMEs lag behind because of many reasons, which need to be explored. This research work deals with the effect of identified variables such as forecasting, planning and control methods adopted, demographics of the key person, standardization practices followed, effect of training, learning and IT usage on firm performance. A model and framework has been developed based on literature. Empirical testing of the model has been done after collecting data using a questionnaire schedule administered among the selected respondents from Small and Medium Enterprises (SMEs) in India. Final data included 382 responses. Hypotheses linking SME performance with the use of forecasting, planning and controlling were formed and tested. Exploratory factor analysis was used for data reduction and for identifying the factor structure. High and low performing firms were classified using a Logistic Regression model. A confirmatory factor analysis was used to study the structural relationship between firm performance and dependent variables.

Sochi 2014 Winter Olympics and the Controversy of the Russian Propaganda Laws: is the IOC Buckling Under the Pressure of its own Incoherence in Thought?

The Sochi Winter Olympics were a triumph in the eyes of Russia and the International Olympic Committee (IOC). Yet, a controversy around the introduction of anti-propaganda laws in Russia that had been criticised for being discriminatory marred the efforts of the IOC to fulfil its self proclaimed aspiration of ‘encouraging the harmonious development of man’. This article discusses the controversy utilising a legally pluralist approach to sports governance, and providing a critical reading of the practices of neoliberal globalisation that marked the issue of sexuality at the Sochi games. The paper argues that the legal influence of the IOC on domestic and international legal norms is contradictory and inconsistent. This, when considered alongside the aspirations of the IOC is significantly problematic and demonstrates the importance of investigating the underlying power structures of this influential international governing body.

Beyond the Acronyms: Sport Diplomacy and the Classification of the International Olympic Committee

Diplomacy often finds itself reduced to actions centred on states. However, after the Cold War, international relations and diplomacy have expanded with different actors growing into significant roles, particularly in the increase of diplomatic relations in the context of sport. The classification and significance of other actors remains under-researched in relation to sport, with literature focusing more on the growth of new and varying practices of diplomacy. This analysis contends that there is a need to interrogate fundamental components of modern diplomacy—with the actor being the focus—more specifically the classification of sports organisations in diplomacy. It is relevant as a more accurate understanding of sports organisations will contribute to how diplomatic studies can analyse and evaluate modern diplomacy within the context of sport. The International Olympic Committee is the actor used to illustrate how problematic classifications currently in the academic literature translate into weak and reduced analysis and evaluation of its role and significance in diplomacy. As counterpoint, this analysis proposes an analytical framework of socio-legal theory that harnesses legal regulation as a benchmark to classify an actor’s capacity within a society. In consequence, the IOC is as an active and significant contributor to the ever expanding and complex diplomatic environment and wider society.

The Impact of Global English in Xinjiang, China: Linguistic Capital and Identity Negotiation among the Ethnic Minority and Han Chinese Students

Thesis (Ph.D.)--University of Washington, 2016-08

We’re just like everyone else!’ Rethinking the cultural politics of the London Asian urban music scene

This article engages with the practices of politics and its presence and meanings within the Asian scene. Despite work that has taken youth cultures beyond the framework of ‘resistance’ youth cultures are often still imagined and understood through the lens of ‘resistance’. Yet, within the Asian scene, the tensions, disavowal and ambivalence towards politics points toward a more complex, multilayered understanding of contemporary youth cultural forms. This article takes into account the politics of location and of belonging that Asians within this scene are negotiating that are shaping the kind of political outlooks and attitudes that are being voiced. The growth of a middle-class 'desi' community in the UK and the rise of neoliberalism has led to a significant decline in the practice of a radical, deliberative politics within this 'desi' scene.

Exploring Children’s Experiences of Participating in a Mindfulness Intervention

In recent years there has been a rapid growth in mindfulness practices being applied to improve the health and wellbeing of those who participate. As a result mindfulness-based interventions (MBI’s) have been applied in medical and educational settings. The purpose of this piece of research is to explore children’s understanding of mindfulness following their involvement in a 12 week mindfulness based intervention. The research provides an in-depth explorative interpretation of both the pupils and the mindfulness practitioner’s experience of mindfulness. Interpretative phenomenological analysis (IPA) was employed as a method of analysis which resulted in 3 master themes being identified. The themes include ‘physiological activities promote mindfulness’, ‘cognitive elements’ and ‘states of being’. Interpretation of the findings considered participants experiences in relation to the 7 attitudinal foundations as proposed by Kabat–Zinn (1990). A number of similarities between the participants were evident, as represented in the 3 master themes. However the degree to which each individual participant expressed their awareness and understating of mindfulness varied. Therefore the findings indicated that the participants were in the process of developing their understanding of mindfulness which differed between them on a conceptual level. This study is considered of relevance for those in the profession of Educational Psychology and those interested in the application of mindfulness-based interventions to improve the health and wellbeing outcomes for children and young people. The research has made a distinctive contribution within the field of mindfulness in light of the findings. Recommendations are made to inform the practices of Educational Psychology Services with reference to the work of Educational Psychologists. Suggestions for further research have also been made to aid the direction of future research.

Resilience of small-scale societies: a view from drylands

To gain insights on long-term social-ecological resilience, we examined adaptive responses of small-scale societies to dryland-related hazards in different regions and chronological periods, spanning from the mid-Holocene to the present. Based on evidence from Africa (Sahara and Sahel), Asia (south margin of the Thar desert), and Europe (South Spain), we discuss key traits and coping practices of small-scale societies that are potentially relevant for building resilience. The selected case studies illustrate four main coping mechanisms: mobility and migration, storage, commoning, and collective action driven by religious beliefs. Ultimately, the study of resilience in the context of drylands emphasizes the importance of adaptive traits and practices that are distinctive of small-scale societies: a strong social-ecological coupling, a solid body of traditional ecological knowledge, and a high degree of internal cohesion and self-organization.

The Effects of a Group-Based Approach to Parent-Mediated Early Behavioral Intervention for Very Young Children with or At-Risk for Autism

Thesis (Ph.D.)--University of Washington, 2016-08

Cosmic Topologies of Imitation: From the Horror of Digital Autotoxicus to the Auto-Toxicity of the Social

This article expands on an earlier concept of horror autotoxicus linked to digital contagions of spam and network Virality.1 It aims to present, as such, a broader conception of cosmic topologies of imitation (CTI) intended to better grasp the relatively new practices of social media marketing. Similar to digital autotoxicity, CTI provide the perfect medium for sharing while also spreading contagions that can potentially contaminate the medium itself. However, whereas digital contagions are perhaps limited to the toxicity of a technical layer of information viruses, the contagions of CTI are an all pervasive auto-toxicity which can infect human bodies and technologies increasingly in concert with each other. This is an exceptional autotoxicus that significantly blurs the immunological line of exemption between self and nonself, and potentially, the anthropomorphic distinction between individual self and collective others.

Meeting the challenges of globalisation in legal education

The focus of this paper is a critical review of the impact of globalisation on international higher education at my own institution, the University of East London (UEL), where I am Programme Leader for LLB (Hons) Law, an undergraduate qualifying law degree. Globalisation, along with internationalisation, has been one of the forces that have most changed the educational landscape in this country over the last two decades. Although closely related to each other, globalisation and internationalisation are usually regarded as distinct forces – the former being defined as the economic, political, and societal forces pushing twenty-first-century higher education towards greater international involvement, while the latter describes the policies and practices of higher education developed to deal with this. Whilst these phenomena have wide implications for higher education as a whole, they present opportunities and challenges that are very specific both to an institution like UEL, which has a high proportion of students from international backgrounds, and to my own discipline, law, which has an increasingly global profile in terms of both legal education and professional practice.

Pathologies of Patriarchy: Death, Suffering, Care and Coping in the Gendered Gaps of HIV/AIDS Interventions in Nigeria

Thesis (Ph.D.)--University of Washington, 2016-08

Continuity of care in older adults with multiple chronic conditions

Thesis (Ph.D.)--University of Washington, 2016-08

The economic crisis as a game changer? Exploring the role of social construction in sustainability transitions

Continuing economic turbulence has fuelled debates about social and political reform as much as it has stimulated actions and initiatives aimed at a more fundamental transition of dominant economic systems. This paper takes a transition perspective to explore, from a Western European viewpoint, how the economic crisis is actually viewed through a variety of interpretations and responded to through a range of practices. We argue that framing societal phenomena such as the economic crisis as "symptoms of transition" through alternative narratives and actions can give rise to the potential for (seemingly) short-term pressures to become game changers. Game changers are then defined as the combination of: specific events, the subsequent or parallel framing of events in systemic terms by engaged societal actors, and (eventually) the emergence of (diverse) alternative narratives and practices (in response to the systemic framing of events). Game changers, when understood in these terms, help to orient, legitimize, guide, and accelerate deep changes in society. We conclude that such dynamics in which game changers gain momentum might also come to play a critical role in transitions. Therefore, we argue for developing a better understanding of and methodologies to further study the coevolutionary dynamics associated with game changers, as well as exploring the implications for governance.